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Rhatomy S, Shiddieqy ABA, Prathama GB, Belantara LAS, Alkarni MD, Septian R, Canintika AF. Sartorius muscle pedicle iliac bone graft for treating neglected femoral neck fracture: A case series. Int J Surg Case Rep 2023; 109:108410. [PMID: 37437327 PMCID: PMC10362283 DOI: 10.1016/j.ijscr.2023.108410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Femoral neck fractures in patients less than 50 years account for less than 5 % of all hip fractures. Controversy remains regarding timing of surgery, operative technique, and optimal implant construct because of a lack of prospective clinical trials. The blood supply to the femoral head is tenuous and easily injured in the setting of displaced fractures. An alternative using sartorius muscle pedicle iliac bone graft has not been discussed widely. CASE PRESENTATION Four patients with neglected femoral neck fracture were included in the series; all underwent cannulated screws fixation and osteomuscular pedicled graft using sartorius muscle. All patients achieved bone healing after 6-months of follow-up. CONCLUSION Our series demonstrate that sartorius muscle pedicle graft may be a good choice for treating neglected femoral neck fractures. Further studies are required to investigate its outcome and complications.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | | | - Ginanjar Budhi Prathama
- Department of Orthopaedics and Traumatology, Siaga Medika Hospital, Banyumas, Central Java, Indonesia
| | | | - Muhammad Dedy Alkarni
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rian Septian
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Sumarwoto T, Suroto H, Utomo DN, Prakoeswa CRS, Tinduh D, Notobroto HB, Arfian N, Rantam FA, Rhatomy S, Mahyudin F. The effect of preconditioning hypoxia in schwann-like-cells-derived adipose mesenchymal stem cells and rat sciatic nerve-derived stem cells: experimental research. Ann Med Surg (Lond) 2023; 85:3439-3445. [PMID: 37427197 PMCID: PMC10328659 DOI: 10.1097/ms9.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/26/2023] [Indexed: 07/11/2023] Open
Abstract
The preconditioning hypoxia for stem cells is a strategy to achieve effective conditions for cell therapy, indicate increased expression of regenerative genes in stem cell therapy, and enhance the secretion of bioactive factors and therapeutic potential of their cultured secretome. Objectives This study aims to explore the response of Schwann-like cells derived from adipose-derived mesenchymal stem cells (SLCs) and Schwann cells rat sciatic nerve-derived stem cells (SCs) with their secretomes under normoxic and hypoxic conditions in vitro. Material and methods SLCs and SCs were isolated from the adipose tissue and the sciatic nerve of the adult white male rat strain Wistar. Cells were incubated in 21% O2 (normoxic group) and 1%, 3%, and 5% O2 (hypoxic group) conditions. Concentration values of transforming growth factor-β (TGF-β), basic Fibroblast Growth factor (bFGF), brain-derived neurotrophic factor, glial-derived neurotrophic factor, vascular endothelial growth factor, and nerve growth factor were detected and calculated utilizing an enzyme-linked immunosorbent assay, and the growth curve was described. Results SLCs and SCs indicated positive expression for mesenchymal markers and negative expression for hematopoietic markers. Normoxic conditions SLCs and SCs showed elongated and flattened morphology. Under hypoxic conditions, SLCs and SCs showed a classic fibroblast-like morphology. Hypoxia 1% gave the highest concentration in TGF-β and bFGF from the SLCs group and TGF-β, bFGF, brain-derived neurotrophic factor, and vascular endothelial growth factor from the SCs group. No significant differences in concentration of growth factors between the SLCs group compared to SCs group in all oxygen groups. Conclusions Preconditioning hypoxia has an effect on the composing of SLCs, SCs, and their secretomes in vitro; no significant differences in concentration of growth factors between the SLCs group compared with the SCs group in all oxygen groups.
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Affiliation(s)
- Tito Sumarwoto
- Doctoral Program of Medical Science, Faculty of Medicine, Airlangga University
- Department of Orthopaedic and Traumatology, Prof. Dr. R. Soeharso Orthopedi Hospital, Faculty of Medicine, Sebelas Maret University, Surakarta
| | | | | | | | - Damayanti Tinduh
- Physical Medicine and Rehabilitation, Dr. Soetomo General Hospital, Faculty of Medicine
| | | | - Nur Arfian
- Department of Anatomy, Faculty of Medicine, Public Health, and Nursing
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Department of Microbiology, Faculty of Veterinary Medicine
- Stem Cell Research and Development Center, Airlangga University
| | - Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, dr. Soeradji Tirtonegoro General Hospital, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
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Rhatomy S, Utomo DN, Prakoeswa CRS, Suroto H, Tinduh D, Notobroto HB, Arfian N, Rantam FA, Mahyudin F. The optimum oxygen level in hypoxic culture conditions of ligament derived stem cells: experimental research. Ann Med Surg (Lond) 2023; 85:2689-2694. [PMID: 37363459 PMCID: PMC10289640 DOI: 10.1097/ms9.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/13/2023] [Indexed: 06/28/2023] Open
Abstract
The hypoxic condition is a physiological norm for various stem cells. The natural microenvironment contains lower oxygen pressures. Recent studies reported significant increases in the cultured cells' proliferation in the presence of a low oxygen pressure. Objective This study aimed to investigate the optimum oxygen level for rabbit cruciate ligament fibroblast cells culture and Ligament Derived Conditioned Medium/LD-CM (Secretome) preparation in vitro. Materials and methods Fibroblasts were isolated from the cruciate ligament of the rabbit's knee. Cultured of rabbit cruciate ligament Fibroblast Cells (fifth passage) were assigned to the slight (5% O2), middle (3% O2), and severe hypoxia (1% O2) groups and the normoxia (21% O2) group. Measurement of growth factors: TGF-β1, PDGF, FGF, and VEGF in LD-CM (Secretome) used an enzyme-linked immunosorbent assay. Results The highest number of cultured cells were in the 5% O2 group compared to the normoxia, 1 and 3% groups. The hypoxia 5% group also had increased productions of PDGF, FGF, and VEGF proteins in LD-CM (secretome) compared to the 1, 3%, and normoxia groups. TGF-β1 production was slightly higher in the 3 group than the 5% group. Conclusion The hypoxic precondition of 5% oxygen was the optimum condition for ligament culture and ligament derived conditioned medium (secretome) preparation in vitro.
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Affiliation(s)
| | | | - Cita R. S. Prakoeswa
- Department of Dermatology and Venereology, Dr Soetomo General Hospital, Faculty of Medicine
| | | | | | | | - Nur Arfian
- Department of Anatomy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fedik A. Rantam
- Stem Cell Research and Development Center
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya
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Pontoh LA, Dilogo IH, Kamal AF, Widodo W, Kholinne E, Rhatomy S, Fiolin J. Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome. Eur J Orthop Surg Traumatol 2023; 33:489-495. [PMID: 36474084 DOI: 10.1007/s00590-022-03432-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Recent studies showed increasing evidences of anterolateral ligament (ALL) reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction that proves to be more superior to the previous double-bundle (DB) ACLR technique especially in improving knee stability in biomechanic studies. However to date, there have been no studies evaluating the functional outcome of DB-ACLR vs single-bundle (SB) with ALL in ACLR. METHODS A total of 138 patients with ACL deficient knee were enrolled to the study. Double-bundle ACL reconstruction (DB-ACLR) was performed in 75 patients and single-bundle ACL reconstruction with anterolateral ligament reconstruction (SB + ALL) ACLR was performed in 63 patients. Surgical outcomes were compared with The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Kujala score at the 3rd, 6th and 9th month post-operative. RESULTS The IKDC score in the 3rd and 6th month was superior in the SB + ALL group compared to the DB group. However, this difference was not statistically significant. In the meantime, there were no statistically significant difference between the Kujala Score at the 3rd, 6th, and 9th months consecutively. There were no statistically significant differences in the functional outcomes of DB-ACLR and SB + ALL groups at the 3rd, 6th, and 9th months post-operative period. CONCLUSION The functional outcome comparison showed non-superiority of SB + ALL group compared to the DB-ACLR group. The patellar pain was less found in DB-ACLR group at 6- and 9-months post-operative period.
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Affiliation(s)
- Ludwig Andre Pontoh
- Department of Orthopedic and Traumatology, Fatmawati General Hospital - Faculty of Medicine, Universitas Indonesiam, Jl. RS Fatmawati No. 4, South Jakarta, 12430, Indonesia.
| | - Ismail Hadisoebroto Dilogo
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jl. Diponegoro No 71, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jl. Diponegoro No 71, Jakarta, Indonesia
| | - Wahyu Widodo
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jl. Diponegoro No 71, Jakarta, Indonesia
| | - Erica Kholinne
- Department of Surgery, St. Carolus Hospital, Jl. Salemba Raya No. 41, Central Jakarta, 10430, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopedic and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Indonesia
- Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jessica Fiolin
- Orthopaedic Surgeon of Jakarta Knee, Shoulder and Orthopedic Sport Clinic, Pondok Indah General Hospital, Jl. Metro Duta Kav UE, South Jakarta, 12310, Indonesia
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Rhatomy S, Pawitan JA, Kurniawati T, Fiolin J, Dilogo IH. Allogeneic umbilical cord mesenchymal stem cell conditioned medium (secretome) for treating posterior cruciate ligament rupture: a prospective single-arm study. Eur J Orthop Surg Traumatol 2023; 33:669-675. [PMID: 35699826 DOI: 10.1007/s00590-022-03278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Outcomes of the current management of posterior cruciate ligament (PCL) rupture are still unsatisfactory. Recent literature demonstrated the efficacy of the paracrine action of mesenchymal stem cells (MSC) in ligament rupture healing. This study aimed to evaluate the outcome of arthroscopic administration of allogeneic umbilical cord-derived MSC (UC-MSC) conditioned medium (secretome) for the treatment of PCL rupture. PATIENTS AND METHODS This is a prospective study including 12 individuals with PCL rupture grade 1 or 2 who were performed arthroscopy and secretome administrations. The functional and radiologic outcome of the knee was examined one year following intervention. RESULTS Preoperatively, posterior drawer test revealed three cases of grade 2+ and nine cases of grade 1+, whereas the final follow-up revealed two cases of grade 2+ and ten cases of grade 1+ PCL rupture. At final follow-up, the mean scores for the IKDC, modified Cincinnati, and Lysholm were 90.58 ± 4.30, 90.90 ± 2.15, and 89.42 ± 3.16, respectively. The means of the serial hop tests were 90.33, 94.16, 93.66, and 95.33 for single, triple, crossover, and time hop tests, respectively. Five patients were able to resume competitive sport after an average of 25.8 weeks (25-38). The final MRI analysis revealed that six knees (50%) regained PCL continuity with low signal intensity, five knees (41.6%) returned near-normal PCL continuity, and one knee (8.3%) regained PCL continuity but with deformed outlines. CONCLUSIONS Short-term follow-up indicated that the secretome generated from allogenic UC-MSC produces excellent functional and radiographic results in grade I-II PCL rupture.
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Affiliation(s)
- Sholahuddin Rhatomy
- Sport and Adult Reconstruction Division, Department of Orthopaedic and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Indonesia.
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Jeanne Adiwinata Pawitan
- Department of Histology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Stem Cell and Tissue Engineering Research Cluster Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jl. Salemba Raya No. 5, Jakarta, Indonesia
| | - Trie Kurniawati
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Diponegoro no. 5, Jakarta, Indonesia
| | - Jessica Fiolin
- Orthopaedic Surgeon of Jakarta Knee, Shoulder and Orthopaedic Sport Clinic, Pondok Indah General Hospital, Jl. Metro Duta Kav UE, Jakarta Selatan, 12310, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jakarta, Indonesia
- Stem Cell and Tissue Engineering Research Cluster Indonesian Medical Education and Research Institute (IMERI), Universitas Indonesia, Jl. Diponegoro no 71, Jakarta, Indonesia
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Rhatomy S, Pontoh LA, Phatama KY, Waskita HC, Al Mashur MI, Fiolin J, Rasyid FA, Utomo DN, Dilogo IH. The Banff Patellar Instability Instrument: validity and reliability of an Indonesian version. Eur J Orthop Surg Traumatol 2023; 33:617-622. [PMID: 35931873 DOI: 10.1007/s00590-022-03336-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The Banff Patellar Instability Instrument (BPII) is a valuable scoring tool for assessing patellofemoral instability in patients suffering from patellofemoral pain syndrome (PFPS). The BPII 2.0 is a shortened version of the BPII. However, there is no Indonesian edition of BPII 2.0 that has been validated. This study aimed to determine the validity and reliability of the Indonesian version of the BPII 2.0. MATERIALS AND METHODS This was a cross-sectional study that used a forward-backward translation protocol to create an Indonesian version of the BPII 2.0. Thirty patients with PFPS were given the questionnaires. The questionnaire's validity was evaluated by analyzing the correlation between score of each subscale and the overall score to the Indonesian version of the Kujala score using Pearson correlation coefficient, while the reliability was evaluated by measuring the internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient). RESULTS The Indonesian version of BPII 2.0 and the Indonesian version of Kujala score had a strong Pearson correlation coefficient for construct validity. For all subscales, Cronbach α was 0.90-0.98, indicating adequate internal consistency. The test-retest reliability was high, with intraclass correlation coefficient ranging from 0.89 to 0.98 for all subscales. There was no difference in the Indonesian version of BPII 2.0 response between the first and second administration of the questionnaire which was taken 7 days afterward. CONCLUSION The Indonesian version of BPII 2.0 was determined to be valid and reliable and is therefore an objective instrument to evaluate patellofemoral instability in patients with PFPS in the Indonesian population.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Ludwig Andre Pontoh
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine, Universitas Indonesia, Jl. RS Fatmawati No. 4, Jakarta Selatan, 12430, Indonesia
| | - Krisna Yuarno Phatama
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Brawijaya-Saiful Anwar General Hospital, Jl. Veteran, Ketawanggede, Kota Malang, Jawa Timur, 65145, Indonesia
| | - Heppy Chandra Waskita
- Orthopaedic Surgeon of Lira Medika Karawang Hospital, Jl. Raya Syeh Quro No. 14, Palumbonsari, Jawa Barat, 41314, Indonesia
| | - Muslich Idris Al Mashur
- General Practitioner of UGM Academic Hospital, Jl. Kabupaten, Kranggahan I, Trihanggo, Daerah Istimewa Yogyakarta, 55291, Indonesia
| | - Jessica Fiolin
- Orthopaedic Surgeon of Jakarta Knee, Shoulder and Orthopaedic Sport Clinic, Pondok Indah General Hospital, Jl. Metro Duta Kav UE, Jakarta Selatan, 12310, Indonesia
| | - Faiz Alam Rasyid
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University, Jl. Veteran, Ketawanggede, Kota Malang, Jawa Timur, 65145, Indonesia
| | - Dwikora Novembri Utomo
- Orthopaedic and Traumatology Department, Faculty of Medicine, Dr Soetomo General Hospital, Surabaya, Universitas Airlangga, Jl. Airlangga 4-6, Surabaya, 60286, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Orthopaedic and Traumatology Department, Faculty of Medicine, RS DR Cipto Mangunkusumo, Jakarta, Jl. Diponegoro no 71, Jakarta, Indonesia
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Romaniyanto FNU, Mahyudin F, Prakoeswa CRS, Notobroto HB, Tinduh D, Ausrin R, Rantam FA, Suroto H, Utomo DN, Rhatomy S. Adipose-Derived Stem Cells (ASCs) for Regeneration of Intervertebral Disc Degeneration: Review Article. SCCAA 2022; 15:67-76. [DOI: 10.2147/sccaa.s379714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022]
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Rhatomy S, Rasyid FA, Romulo MA, Lumban-Gaol I, Budhiparama NC. Adductor canal block in outpatient clinic for pain control after knee arthroplasty: A randomized controlled, clinical trial. J Orthop Surg (Hong Kong) 2022; 30:10225536221122246. [PMID: 35993223 DOI: 10.1177/10225536221122246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Successful total knee replacement surgery is influenced by surgery and rehabilitation program. We hypothesized the adductor canal block (ACB) in the outpatient clinic is safe, effective for pain relief and decreases analgesic consumption compared with controls. METHODS a paired, randomized controlled trial. The intervention group received ACB with 15 mL mixture of ropivacaine 0.2% with isotonic saline and steroids on post-operative day 14 (POD-14) at the outpatient clinic, the control group received daily consumption of analgesic. We evaluated Visual Analog Score (VAS) pain score, and analgesic consumption. RESULTS 35 subjects for each group. In the ACB group, mean of age was 66.42 years old, mean of BMI was 25.87. The control group, mean of age was 64.11 years old, mean of BMI was 25.95. There were significantly different mean VAS scores of both groups and analgesic consumption of both groups on POD 15th, 17th and 19th (p = 0.00, 0.000 and 0.001, respectively). Two patients complained about hematoma in their thigh (insertion needle) and recovered. CONCLUSIONS Single-shot ACB in the outpatient clinic is safe, significantly decreased pain and analgesic consumption and may enhance the rehabilitation program.
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Affiliation(s)
- Sholahuddin Rhatomy
- Sport and Adult Reconstruction Division, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health, and Nursing, 95455Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Faiz A Rasyid
- Department of Orthopaedics and Traumatology, Dr. Saiful Anwar General Hospital, Malang, Indonesia; Faculty of Medicine, 354487University of Brawijaya, Malang, Indonesia
| | - Michael A Romulo
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health, and Nursing, 95455Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Imelda Lumban-Gaol
- Arthroplasty & Sports Medicine, Medistra Hospital, Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation, Jakarta, Indonesia
| | - Nicolaas C Budhiparama
- Arthroplasty & Sports Medicine, Medistra Hospital, Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation, Jakarta, Indonesia
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Sumarwoto T, Suroto H, Mahyudin F, Utomo DN, Romaniyanto FNU, Prijosedjati A, Notobroto HB, Tinduh D, Prakoeswa CRS, Rantam FA, Rhatomy S. Prospect of Stem Cells as Promising Therapy for Brachial Plexus Injury: A Systematic Review. Stem Cells Cloning 2022; 15:29-42. [PMID: 35770243 PMCID: PMC9234311 DOI: 10.2147/sccaa.s363415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 12/09/2022] Open
Abstract
Background Brachial plexus injury is an advanced and devastating neurological injury, for which both nerve surgery and tendon transfers sometimes remain insufficient in restoring normal movement. Stem cell therapy may be applicable to rescue the injured motor neurons from degeneration which potentially improves muscle strength. Study Design Systematic Review; Level of evidence V. Data Sources A systematic literature search was conducted on PubMed (MEDLINE), EMBASE, the Cochrane Library, and Scopus using the terms ("stem cell") AND ("brachial plexus") as search keywords. Methods The process of study selection was summarized by PRISMA flow diagram. The study included in vivo and in vitro studies with English language, humans or animals with some brachial plexus injuries, interventions, some applications of stem cells to the groups of study, with functional, biomechanical, or safety outcomes. Results In total, there were 199 studies identified from the literature sources where 75 articles were qualified for forward evaluation following selecting the titles and abstracts. Ten studies were finally included in this systematic review after full-text assessment. Stem cells can produce neurotrophic factors in vitro and in vivo in rats, and their level was increased after injury. Electrophysiological measurement showed that the intervention group had distinctly higher CMAP amplitude and evidently shorter CMAP latency than the model group. Application of bone marrow stem cells (BMSCs) showed an elevation in the numbers of axons and density of myelinated fibers, the density of nerve fibers, the diameter of regenerating axons, and a decrease in axonal degeneration. A study in humans indicated an improvement of the movements in a patient with traumatic total BPI after injection of Ad-MSC. It is associated with increased muscle mass and sensory recovery and also suggested that mononuclear cell injection enhances muscle regeneration and reinnervation in the partly denervated muscle of brachial plexus injury. Various muscle groups had obtained strength together with restoration, the muscle strength attained after the previous transplantation were preserved. The results of this review support stem cell treatment in brachial plexus injury. Conclusion This review provides evidence of the positive effects of stem cell treatment in brachial plexus injury.
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Affiliation(s)
- Tito Sumarwoto
- Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Heri Suroto
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - F N U Romaniyanto
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Andhi Prijosedjati
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital/Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | | | - Damayanti Tinduh
- Physical Medicine and Rehabilitation Department, Universitas Airlangga, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia
- Stem Cell Research and Development Center, Airlangga University, Surabaya, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
- Faculty of medicine, public health and nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Romaniyanto, Mahyudin F, Prakoeswa CRS, Notobroto HB, Tinduh D, Ausrin R, Rantam FA, Suroto H, Utomo DN, Rhatomy S. Hypoxia Effects in Intervertebral Disc-Derived Stem Cells and Discus Secretomes: An in vitro Study. Stem Cells Cloning 2022; 15:21-28. [PMID: 35655962 PMCID: PMC9153942 DOI: 10.2147/sccaa.s363951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 12/17/2022] Open
Abstract
Background This study aimed to investigate the effects of hypoxia and normoxia preconditioning in rabbit intervertebral disc-derived stem cells (IVDSCs) and discus-derived conditioned medium (DD-CM)/secretomes in vitro. Transforming growth factor (TGF)-β1, platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) have a role in the proliferation, development, differentiation, and migration of MSCs. Materials and Methods Intervertebral discs were isolated from rabbit and incubated in normoxia and hypoxia 1%, 3%, and 5% (hypoxia groups) condition. Cell counting was performed after 24 hours of manipulation, then analyzed using one-way ANOVA. TGF-β1, PDGF, FGF, and VEGF were measured using the ELISA. Results The highest number of cells was in the hypoxia 3% preconditioning compared to the normoxia, hypoxia 1%, and hypoxia 5% groups. Hypoxia 3% also had the highest increase in PDGF protein production compared to normoxia, with hypoxia 1% and 5%. Among hypoxia groups, the highest secretions of VEGF and FGF proteins were in the hypoxia 3% group. Based on TGF-β1 protein measurement, the hypoxia 1% group was the highest increase in this protein compared to other groups. Conclusion Oxygen level in hypoxia preconditioning has a role in the preparation of IVDSCs and secretome preparation in vitro. The highest cell numbers were found in the treatment group with 3% hypoxia, and 3% hypoxia was significantly related to support IVDSCs preparation. Preconditioning with 3% hypoxia had higher PDGF and VEGF levels than other hypoxia groups.
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Affiliation(s)
- Romaniyanto
- Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia.,Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Dermatology and Venereology, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | | | - Damayanti Tinduh
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Physical Medicine and Medical Rehabilitation, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ryan Ausrin
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia.,Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia.,Stem Cell Research and Development Center, Airlangga University, Surabaya, Indonesia
| | - Heri Suroto
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopedic and Traumatology, Dr. Soetomo General Hospital, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Santoso A, Phatama KY, Rhatomy S, Budhiparama NC. Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review. World J Orthop 2022; 13:503-514. [PMID: 35633748 PMCID: PMC9125004 DOI: 10.5312/wjo.v13.i5.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/07/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.
AIM To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.
METHODS A literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.
RESULTS Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.
CONCLUSION At least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.
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Affiliation(s)
- Asep Santoso
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Surakarta and Prof. Dr. R. Soeharso Orthopaedic Hospital, Sukoharjo 57162, Indonesia
| | - Krisna Yuarno Phatama
- Department of Orthopaedic and Traumatology, Universitas Brawijaya, Saiful Anwar General Hospital, Malang 65112, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, Universitas Gadjah Mada, Yogyakarta and Dr. Soeradji Tirtonegoro General Hospital, Klaten 57424, Indonesia
| | - Nicolaas Cyrillus Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation at Medistra Hospital, Jakarta 12950, Indonesia
- Faculty of Medicine, Universitas Airlangga, Jawa Timur 60132, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden 2333, Netherlands
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Maodah FA, Rhatomy S. Management of Neglected Multiple Ligament Rupture of the Knee: A Case Report. Malays Orthop J 2021; 15:118-121. [PMID: 34966505 PMCID: PMC8667252 DOI: 10.5704/moj.2111.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
Delayed or neglected multiple ligament injury of the knee is challenging or doctors and physiotherapists. We report on a 36-year-old army man who presented to the outpatient orthopaedic department with complaints of pain and deformity of his right knee and an inability to weight-bear on the right leg. The examination of the right knee revealed an unreduced posterior dislocation of the knee with instability in all planes and a limited range of motion (ROM) from 10° to 100°. Quadriceps wasting was noted. Roentgenograms revealed a posterior dislocation of the knee. Magnetic resonance imaging (MRI) showed complete rupture of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and the patellar tendon. A two-stage surgery was planned, involving soft tissue distraction with external fixation to restore the knee joint, followed by multiple ligament reconstruction. Three months after surgery, the patient could walk normally with ROM between 0° to 120°.
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Affiliation(s)
- F A Maodah
- Department of Orthopedics and Traumatology, University of Airlangga, Surabaya, Indonesia
| | - S Rhatomy
- Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine Public Health Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Rhatomy S, Utomo DN, Prakoeswa CRS, Rantam FA, Suroto H, Mahyudin F. Ligament/Tendon Culture under Hypoxic Conditions: A Systematic Review. Adv Pharm Bull 2021; 11:595-600. [PMID: 34888206 PMCID: PMC8642806 DOI: 10.34172/apb.2021.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 10/18/2020] [Indexed: 12/09/2022] Open
Abstract
The hypoxic environment is a substantial factor in maintenance, proliferation, and differentiation of the cell cultures. Low oxygen is known as a potent chondrogenesis stimulus in stem cells that is important for clinical application and engineering of functional cartilage. Hypoxia can potentially induce angiogenesis process by secretion of cytokines. This systematic review goal is to discover the effect of hypoxic condition on tendon/ ligament culture and the best oxygen level of hypoxia for in vitro and in vivo studies. We included 21 articles. A comprehensive review of this database confirms that the hypoxic condition is a substantial factor in the maintenance, proliferation, and differentiation of ligament/tendon cultures. Cell proliferation in the severe hypoxic (oxygen concentration of 1%) group at 24 h postcultivation was considered significant, but cell proliferation was markedly inhibited in the severe hypoxic group after 48 h.
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Affiliation(s)
- Sholahuddin Rhatomy
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedic and Traumatology, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya Indonesia.,Stem Cell Research and Development Center, Universitas Airlangga, Surabaya Indonesia
| | - Heri Suroto
- Department of Orthopaedic and Traumatology, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedic and Traumatology, Dr. Soetomo General Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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Singh C, Vellasamy SD, Fiolin J, Rhatomy S. Cyclops lesion - The entity causing loss of knee extension after ACL reconstruction surgery: A case report. Int J Surg Case Rep 2021; 88:106554. [PMID: 34741861 PMCID: PMC8577123 DOI: 10.1016/j.ijscr.2021.106554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022] Open
Abstract
Cyclops is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction surgery that causes loss of knee extension. In this literature, we have discussed about a young gentleman who presented with unresolved swelling and inability to extend knee joint fully 1 year after ACL reconstruction surgery. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). An arthroscopic excision of the cyclops lesion was successfully done on this patient which resulted in a resolution of swelling and progressive improvement of knee extension.
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Affiliation(s)
- Charanjeet Singh
- Department of Orthopaedic & Trauma Surgery, Gleneagles Hospital Kuala Lumpur, Malaysia
| | | | - Jessica Fiolin
- Jakarta Knee, Shoulder and Orthopaedic Sport Clinic, Pondok Indah Hospital, Jl. Metro Duta Kav UE, Jakarta 12310, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, Soeradji Tirtonegoro Hospital, Klaten, Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Sumarwoto T, Suroto H, Mahyudin F, Utomo DN, Romaniyanto R, Prijosedjati A, Utomo P, Prakoeswa CRS, Rantam FA, Tinduh D, Notobroto HB, Rhatomy S. Preconditioning of Hypoxic Culture Increases The Therapeutic Potential of Adipose Derived Mesenchymal Stem Cells. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Various in vitro preconditioning strategies have been implemented to increase the regenerative capacity of MSCs. Among them are modulation of culture atmosphere (hypoxia or anoxia), three-dimensional culture (3D), addition of trophic factors (in the form of growth factors, cytokines or hormones), lipopolysaccharides, and pharmacological agents. Preconditioning mesenchymal stem cells by culturing them in a hypoxic environment, which resembles the natural oxygen environment of the tissues (1% –7%) and not with standard culture conditions (21%), increases the survival of these cells via Hypoxia Inducible Factor-1α (HIF-1a) and via Akt-dependent mechanisms. In addition, the hypoxic precondition stimulates the secretion of pro-angiogenic growth factors, increases the expression of chemokines SDF-1 (stromal cell-derived factor-1) and its receptor CXCR4 (chemokine receptor type 4) - CXCR7 (chemokine receptor type 7) and increases engraftment of stem cell. This review aims to provide an overview of the preconditioned hypoxic treatment to increase the therapeutic potential of adipose-derived mesenchymal stem cells.
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Rhatomy S, Setyawan R, Romulo MA. Enhancement of Chondrogenesis in Hypoxic Precondition Culture: A Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Cartilage tear has begun to be treated with stem cells. However, stem cell oxygen level culture has not been evaluated for the best environment to enhance chondrogenesis.
AIM: The purpose of this review is to focus on the hypoxic oxygen level of stem cells culture as a treatment for cartilage tear.
METHODS: A literature search was systemically conducted on PubMed (MEDLINE), OVID, EMBASE, the Cochrane Library, Scopus, Web of Science, Science Direct, Wiley Online Library, Google Scholar, and bibliography of selected articles with the terms (“culture”) AND (“stem cell” OR “mesenchymal stem cell” OR “MSC”) AND (“hypoxic” OR “hypoxia”) AND (“cartilage” OR “chondro*”) as the main keywords. A total of 438 articles were reviewed. Thirty-six articles were considered relevant for this systematic review.
RESULTS: The result of this review supports stimulation effects of hypoxic oxygen level stem cell culture in chondrogenesis process. Most studies used 5% oxygen concentration for culture, both of in vivo and in vitro studies. Due to the heterogeneity nature of the included studies, meta-analysis was unable to be conducted.
CONCLUSION: Hypoxia state seems to play an important role in chondrocytes proliferation, differentiation, and matrix production.
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Nugroho AN, Dina Soraya AA, Prawirohardjo AN, Rhatomy S. Management of colocutaneus fistula with laparoscopic surgery: Case report. Ann Med Surg (Lond) 2021; 70:102883. [PMID: 34745597 PMCID: PMC8551405 DOI: 10.1016/j.amsu.2021.102883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/19/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Colocutaneous fistulas can occur as the result of complications from diverticular colon surgery. Enterocutaneous fistula is a type of fistula that accounts for about 88.2% of all fistulas. In this report, we describe a case reports of the management of colocutaneous fistula with laparoscopic surgery. CASE PRESENTATION In this case reports, both patients complained of increased amount of abdominal discharge after surgery. In Case 1, a 43-year-old female patient complained of a lump in her lower abdomen which had been there for three months. After removal of the lump, there was blood in the drainage tube. After three months, her surgeon advised to close the stoma. In Case 2, a 47-year-old male patient lived with colocutaneous fistula for a year. He had been involved in a traffic accident and underwent laparotomy sigmoidostomy. Both patients experienced pain, and there also were feces and bad odor coming out from the surgical incision. Then, both patients underwent colonoscopy, which revealed coloncutaneous fistulas. Laparoscopic surgery was conducted and there was adhesion between the sigmoid colon and ileum in the ventral abdomen wall. After the laparoscopic procedure, the patients were discharged 3 days later without any complaints. CONCLUSIONS Laparoscopic colectomy has recently replaced open resection as standard surgery. This procedure is safe, feasible, and effective for diverticular disease.
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Affiliation(s)
- Anung Noto Nugroho
- Digestive Division, Department of Surgery, Sebelas Maret University, Moewardi General Hospital, Surakarta, Indonesia
- Ph.D. Candidate, Sebelas Maret University, Surakarta, Indonesia
| | - Alia Adelina Dina Soraya
- Resident of Surgery, Faculty of Medicine, Sebelas Maret University, Moewardi General Hospital, Surakarta, Indonesia
| | - Arif Nurhidayat Prawirohardjo
- Digestive Division, Department of Surgery, Sebelas Maret University, Moewardi General Hospital, Surakarta, Indonesia
| | - Sholahuddin Rhatomy
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia/ Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Phatama KY, Darmawansa R, Oktafandi IGNAA, Cendikiawan F, Pribadi A, Siahaan LD, Rhatomy S, Mustamsir E. Higher Rate of Patellofemoral Problems After Anterior Cruciate Ligament Reconstruction using Hamstring Autograft. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Patellofemoral problems are not uncommon among post-anterior cruciate ligament (ACL) reconstruction patients. Hamstring autograft harvesting-related factor is one of the suspected causes. A lack of tibiofemoral internal rotation force due to strength deficit causes the patella tends to shift laterally.
Purposes: Peroneus longus tendon has been proposed as an alternative graft source due to its adequate tensile strength and minimal donor site morbidity to the knee biomechanics, including the patellofemoral joint. This tendon does not cross the knee joint and thus does not affect patellofemoral alignment and biomechanics. This study aims to compare patellofemoral problems between hamstring and peroneus longus autograft harvested-patients following ACL reconstruction.
Material and methods: Thirty-one subjects who underwent primary single-bundle ACL reconstruction between September 2018 and September 2019 and met the inclusion criteria were grouped into the hamstring group (n=16) and peroneus longus group (n=15). Both groups were evaluated retrospectively. The follow-up assessment was conducted on the phase II rehabilitation program. The assessed variables were pain, crepitus, and the Indonesian-validated Kujala score.
Results: No significant differences in pain and crepitus were found between both groups. There were significant differences in the Kujala score between both groups (P < .001). The peroneus longus group reported an averagely higher score than the hamstring group.
Conclusion: Single bundle ACL reconstruction using peroneus longus tendon autograft produces less patellofemoral symptoms and functional limitation than using hamstring tendon autograft.
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Pontoh LA, Rahyussalim AJ, Widodo W, Fiolin J, Rhatomy S. Anthropometric study as a predictor of anterior cruciate ligament sizes in Asian Indonesian population. J Orthop Surg (Hong Kong) 2021; 29:23094990211000462. [PMID: 33745362 DOI: 10.1177/23094990211000462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate whether anthropometric data can predict anterior cruciate ligament (ACL) sizes on magneti resonance imaging (MRI) in Asian population. BACKGROUND Reconstruction of ACL has been performed over a decade ago. Recently, more individualized ACL reconstruction is performed taking account of each patient's ACL characteristics. However, there has been limited study regarding ACL sizes in Asian Indonesian population. This study aimed to evaluate the role of anthropometric data in ACL sizes using MRI in Asian Indonesian population. STUDY DESIGN Retrospective Study. METHOD A series of 531 knees from 420 patients with knee pain and intact ACL confirmed by MRI study. Length, width and inclination angle of ACL were measured using a T2-weighted sagittal MRI 3.0 Tesla Magnetom Skyra. Height, weight, body mass index (BMI) and age were recorded. Multiple regression analysis was used to determine relationship between the anthropometric data and size of ACL measurements. RESULT ACL length and width were significantly different between male and female, consecutively. Mean ACL length was 35.36 ± 3.63 mm, male was significantly longer (36.59 ± 3.24 mm) compared to female (32.77 ± 2.99 mm), p < 0.0001. Mean ACL width was 10.23 ± 1.84 mm, male was significantly wider (10.85 ± 1.59 mm) compared to female (8.93 ± 1.64 mm), p < 0.0001. The mean ACL inclination angle was 47.75° ± 3.07° (range 40.17°-57.12°). The strongest correlation for ACL length was height and weight (r = 0.437; r = 0.341 consecutively, p < 0.0001). Females had stronger correlation compared to males for ACL length (R2 = 0.489 vs R2 = 0.418). ACL width showed weak correlation with anthropometric data. The following regression analysis equation was obtained for ACL length: ACL length = 60.697 - 0.11*age + 0.461*weight (kg) - 16.522*height (meter) - 1.093*BMI (R2 = 0.539; p < 0.0001). CONCLUSION Anthropometric data can be utilized as a predictor of ACL length in Asian Indonesian population. The ACL length in Asian Indonesian population is shorter than that in Western population study.
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Affiliation(s)
- Ludwig Ap Pontoh
- Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.,Faculty of Medicine, 64733Universitas Indonesia, Jakarta, Indonesia
| | - Ahmad Jabir Rahyussalim
- Faculty of Medicine, 64733Universitas Indonesia, Jakarta, Indonesia.,Department of Orthopaedics and Traumatology, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Wahyu Widodo
- Faculty of Medicine, 64733Universitas Indonesia, Jakarta, Indonesia.,Department of Orthopaedics and Traumatology, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Jessica Fiolin
- Department of Orthopaedics and Traumatology, Pondok Indah General Hospital, Jakarta, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health and Nursing, 59166Universitas Gadjah Mada, Yogyakarta, Indonesia
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Budhiparama NC, Rhatomy S, Phatama KY, Chandra W, Santoso A, Lumban-Gaol I. Peroneus Longus Tendon Autograft: A Promising Graft for ACL Reconstruction. Video Journal of Sports Medicine 2021. [DOI: 10.1177/26350254211009888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: With the increasing use of hamstring tendon as an autograft in anterior cruciate ligament (ACL) reconstruction, some shortcomings have been found on the donor site. Therefore, an alternative autograft option with adequate strength and less donor site morbidity will be very valuable. Peroneus longus tendon has been found to be a promising option. Indication: Primary ACL reconstruction. Technique Description: Peroneus longus tendon graft is harvested with a longitudinal skin incision at 2 to 3 cm (2 finger-breadths) above and 1 cm (1 finger-breadth) behind the lateral malleolus, followed by superficial fascia incision in line with skin incision. The peroneus longus and peroneus brevis tendons were then identified. The tendon division location was marked at 2 to 3 cm above the level of the lateral malleolus. After that, an end-to-side suture was performed between the distal part of the peroneus longus tendon and peroneus brevis tendon. The peroneus longus tendon was stripped proximally with a tendon stripper to at least 5 cm from the fibular head to prevent peroneal nerve injury. Graft preparation was performed with a standard procedure to obtain the suitable graft size. In routine arthroscopic ACL reconstruction, peroneus longus tendon graft fixation can be performed with a cortical suspension device, bioabsorbable screws, or a combined technique. Results: Recent studies showed that peroneus longus autograft had a comparable outcome with hamstring tendon autograft in primary ACL reconstruction at a 1-year follow-up. The use of peroneus longus tendon autograft resulted in larger graft diameter and less thigh hypotrophy. The mean (±SD) for the AOFAS-Hindfoot Score in the peroneus longus group was 97.3 ± 4.2, while the mean FADI score was 98 ± 3.4, both of which were considered excellent results. Discussion/Conclusion: The use of peroneus longus autograft in primary ACL reconstruction is a safe procedure with an excellent outcome. Peroneus longus tendon autograft can be recommended as an alternative graft in single-bundle ACL reconstruction. Further study of the functional outcome and knee stability evaluation is recommended.
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Affiliation(s)
- Nicolaas C. Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital, Jakarta, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Sport and Adult Reconstruction Division, Department of Orthopedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Krisna Yuarno Phatama
- Sport and Adult Reconstruction Division, Department of Orthopaedics and Traumatology, Dr Saiful Anwar General Hospital, Malang, Indonesia
| | - William Chandra
- Sport and Adult Reconstruction Division, Department of Orthopaedics and Traumatology, Sulianti Saroso Infection Center Hospital, Jakarta, Indonesia
| | - Asep Santoso
- Sport and Adult Reconstruction Division, Department of Orthopaedics and Traumatology, Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty & Sports Medicine, Medistra Hospital, Jakarta, Indonesia
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Sumarwoto T, Suroto H, Mahyudin F, Utomo DN, Romaniyanto, Tinduh D, Notobroto HB, Sigit Prakoeswa CR, Rantam FA, Rhatomy S. Role of adipose mesenchymal stem cells and secretome in peripheral nerve regeneration. Ann Med Surg (Lond) 2021; 67:102482. [PMID: 34168873 PMCID: PMC8209190 DOI: 10.1016/j.amsu.2021.102482] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 01/08/2023] Open
Abstract
The use of stem cells is a breakthrough in medical biotechnology which brings regenerative therapy into a new era. Over the past several decades, stem cells had been widely used as regenerative therapy and Mesenchymal Stem Cells (MSCs) had emerged as a promising therapeutic option. Currently stem cells are effective therapeutic agents againts several diseases due to their tissue protective and repair mechanisms. This therapeutic effect is largely due to the biomolecular properties including secretomes. Injury to peripheral nerves has significant health and economic consequences, and no surgical procedure can completely restore sensory and motor function. Stem cell therapy in peripheral nerve injury is an important future intervention to achieve the best clinical outcome improvement. Adipose mesenchymal stem cells (AdMSCs) are multipotent mesenchymal stem cells which are similar to bone marrow-derived mesenchymal stem cells (BM-MSCs). The following review aims to provide an overview of the use of AdMSCs and their secretomes in regenerating peripheral nerves.
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Affiliation(s)
- Tito Sumarwoto
- Doctoral Program, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital, Sebelas Maret University, Surakarta, Indonesia.,Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Heri Suroto
- Department of Orthopaedic and Traumatology, dr. Soetomo General Hospital, Airlangga University, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedic and Traumatology, dr. Soetomo General Hospital, Airlangga University, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedic and Traumatology, dr. Soetomo General Hospital, Airlangga University, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Romaniyanto
- Department of Orthopaedics and Traumatology, Prof Soeharso Orthopaedic Hospital, Sebelas Maret University, Surakarta, Indonesia.,Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia
| | - Damayanti Tinduh
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia.,Physical Medicine and Rehabilitation Department, Universitas Airlangga, Surabaya, Indonesia
| | | | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, dr. Soetomo General Hospital, Airlangga University, Surabaya, Indonesia.,Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Fedik Abdul Rantam
- Virology and Immunology Laboratory, Microbiology Department, Faculty of Veterinary Medicine, Airlangga University, Surabaya, Indonesia.,Stem Cell Research and Development Center, Airlangga University, Surabaya, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
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22
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Thabrani A, Hadi WS, Thobari JA, Novianti Z, Kurniyanto, Juliana I, Suharto A, Danaswari AN, Septiani I, Rhatomy S. Convalescent plasma as a treatment modality for Coronavirus Disease 2019 in Indonesia: A case reports. Ann Med Surg (Lond) 2021; 66:102444. [PMID: 34094533 PMCID: PMC8165043 DOI: 10.1016/j.amsu.2021.102444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction and importance Coronavirus Disease 2019 (COVID-19) has become a pandemic since the beginning of 2020. COVID-19 is also spreading very rapidly in Indonesia and so far, no definitive therapy has been found. Case presentation We report two cases of confirmed COVID-19 with moderate pneumonia, who received 400 ml of convalescent plasma and showed improvements in clinical, laboratory and radiological examinations. Clinical discussion Passive immunotherapy is generally more effective when given early. Plasma transfusion is more beneficial when given before clinical conditions become severe. Some studies have shown that therapy with convalescent plasma can contribute to a longer survival and a lower length of stay. Conclusion Convalescent plasma can be used as an adjunctive therapy option for patients with moderate COVID-19.
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Affiliation(s)
- Achmad Thabrani
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wahid Syamsul Hadi
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jarir At Thobari
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta, Indonesia
| | - Zakiah Novianti
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Kurniyanto
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Indah Juliana
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Agus Suharto
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Atik Nuriyah Danaswari
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ika Septiani
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sholahuddin Rhatomy
- Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Rhatomy S, Dilogo IH. Core Decompression and Biological Treatment in Osteonecrosis of the Hip due to Systemic Lupus Erythematosus, 8-year Follow-up: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Osteonecrosis most commonly affects the femoral head, especially in middle-aged adults. It can be caused by trauma, chronic inflammation, or infection. It leads to collapse of the entire femoral head and culminates with total hip replacement.
CASE REPORT: A 29-year-old female with systemic lupus erythematosus (SLE) had a chief complaint of bilateral hip pain. She was diagnosed with early osteonecrosis of the femoral head (FICAT stage II) using magnetic resonance imaging and core decompression surgery was performed using three small diameter (4 mm) drillings and added biological treatment. She was evaluated with a visual analog scale (VAS), Harris hip score (HHS), and plain radiography in the pre-operative stage and post-operative follow-up.
RESULTS: Functional outcome at 8-year follow-up showed improvement with significantly decreased VAS (pre-operative: 5, post-operative: 0), significant improvement of HHS from 52.725 points (poor) pre-operative to 92.025 points (excellent) post-operative, and subsided femoral head lesion.
CONCLUSIONS: Surgical decompression and biological treatment result in decreased intraosseous pressure and enhanced osteogenesis. It can restrict the SLE disease progression and limit the number of cell death.
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Solichin I, Sandjaya G, Prabowo I, Dwi Putra NH, Rhatomy S. The lateral curved osteotomy for cubitus varus deformity in children: A case report and literature review. Ann Med Surg (Lond) 2021; 65:102315. [PMID: 33996051 PMCID: PMC8091879 DOI: 10.1016/j.amsu.2021.102315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cubitus varus deformity after malunited supracondylar humerus fracture has various surgical techniques, implant configurations, and approaches. We describe a combination of French and Dome osteotomy and novel internal fixation technique to deliver an easy, safe, fast and reproducible result based on the current best evidence. Presentation of case Two cases of malunited supracondylar humerus are described. The first case involves a 3-year-old girl who presented with outstretched and supinated left arm after falling during bike riding 3 weeks earlier. We found no abnormality in radial and median nerve function, but the left arm radiographs showed a callus formation and the early stages of a malunited fracture of the supracondylar humerus. We waited two months for further radiographic evaluation and the radiographs showed the malunited supracondylar humerus with elbow flexion of only 105° and elbow hyperextension of 20°. The cubitus varus was recorded with clinical carrying angle of varus 10°. We used a combination of original French and Dome osteotomy, lateral approach, and our novel fixation technique with excellent results. The second case involved a 8-year-old boy with malunited right elbow and the surgery was done in the same manner, with the result of restoration to normal elbow range of motion. We also assessed the pain score and disabilities of the arm, shoulder and hand (DASH) score and recorded satisfactory results. Conclusions The combination of French and Dome osteotomy for treatment of cubitus varus deformity can provide an easy, safe, and reproducible result. Cubitus varus deformity. Malunited supracondylar humerus. French osteotomy. Dome osteotomy.
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Affiliation(s)
- Iman Solichin
- Orthopaedic Hospital Purwokerto, Network Hospital of Department Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Indonesia
| | - Gede Sandjaya
- Soedarso Hospital Pontianak, Network Hospital of Department Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Indonesia
| | - Ido Prabowo
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Nurmansyah Hata Dwi Putra
- Department of Orthopaedics and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Sholahuddin Rhatomy
- Sport and Adult Reconstruction Division, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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25
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Marliana A, Setyopranoto I, Setyaningsih I, Rhatomy S. The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-analysis. Anesth Pain Med 2021; 11:e111420. [PMID: 34336613 PMCID: PMC8314080 DOI: 10.5812/aapm.111420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/10/2021] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
Context Radiofrequency therapy is a medical procedure mainly used to reduce pain with a low complication rate (less than 1%), ease of application, and low cost. This review's objective was to (1) evaluate the pulsed radiofrequency (PRF) effectiveness in treating radicular pain and (2) assess the PRF procedure's safety in managing radicular pain in lumbar herniated nucleus pulposus (HNP). Methods A systematic review and meta-analysis. A tertiary care center and an academic medical center. Six full articles with the following features were selected for this review: (1) Articles published in English; (2) studies on the PRF effect on radicular pain in lumbar HNP; and (3) randomized control trials. Results The studies showed that the PRF group had a reduction in pain scores at each evaluation. In four of the studies, the PRF group showed a more significant reduction in pain scores than the control, and in two of the studies, the reduction in pain scores was not significant in the PRF group compared to the control. An adverse effect was reported in one patient experiencing increased radicular pain after PRF. Lack of data required for statistical analysis, and lack use of a uniform duration for the PRF procedure by all the studies. Conclusions PRF can be used as a promising clinical recommendation for pain management with minimally invasive radicular pain techniques due to lumbar HNP.
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Affiliation(s)
- Anita Marliana
- Department of Neurology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Indarwati Setyaningsih
- Department of Neurology, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sholahuddin Rhatomy
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
- Corresponding Author: Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.
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26
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Rhatomy S, Rahmadian R, Alam Rasyid F, Margaretha E. Adductor Canal Block in the Outpatient Clinic for Pain Control Following Knee Surgery. Anesth Pain Med 2021; 11:e110904. [PMID: 34221939 PMCID: PMC8239381 DOI: 10.5812/aapm.110904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/01/2021] [Accepted: 01/12/2021] [Indexed: 01/14/2023] Open
Abstract
Background Effective postoperative pain control is an important factor for the success of rehabilitation programs. Adductor canal block (ACB) is a recently developed technique. Objectives This study aimed to evaluate the application of ACB in patients who underwent knee surgery. Methods We performed ACB guided with ultrasonography for patients who underwent knee surgery. ACB was performed 14 days after surgery in the outpatient clinic with a ropivacaine mixture. The pain was evaluated using the visual analogue scale (VAS) every two days. Results In this study, 115 patients were included. The mean score of VAS before ACB on the fifth, seventh, and ninth days was 7.4, 7.2, and 6.2, respectively. Mean VAS was significantly decreased after providing the intervention. However, the VAS score was increased gradually until the 23rd day and then flattened. Analgesic (etoricoxib) consumption was 102 mg, 98 mg, and 98 mg in postoperative days (POD), 5th, 7th, and 9th, respectively. Analgesic consumption was significantly decreased (16 mg) after ACB (POD 15th) and gradually increased in PODs 17th, 19th, and 21st. Only one patient complained of thigh hematoma after the ACB procedure. Conclusions Single-shot ACB, provided in outpatient clinics, is a safe intervention that could significantly decrease both pain and analgesic consumption. It may enhance the postoperative rehabilitation program.
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Affiliation(s)
- Sholahuddin Rhatomy
- Sport and Adult Reconstruction Division, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Corresponding Author: Sport and Adult Reconstruction Division, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.
| | - Rizki Rahmadian
- Sport and Adult Reconstruction Division, Department of Orthopaedics and Traumatology, Dr. M. Djamil General Hospital, Padang, Indonesia
- Faculty of Medicine, University of Andalas, Padang, Indonesia
| | - Faiz Alam Rasyid
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Evlin Margaretha
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Baiturrahmah University, Padang, Indonesia
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27
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Pontoh LA, Dilogo IH, Hartono F, Rhatomy S, Fiolin J. Meniscal bearing dislocation following minimally invasive Oxford medial unicompartmental knee arthroplasty treated with simple open reduction: Case report. Int J Surg Case Rep 2021; 79:371-374. [PMID: 33516053 PMCID: PMC7847823 DOI: 10.1016/j.ijscr.2021.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Dislocation of polyethylene insert is one of the most common complications of mobile bearing-medial unicompartmental knee arthroplasty (MUKA). Bearing dislocation was diagnosed by radiograph examination in these cases upon trivial injury. CASE PRESENTATION We reported one case of meniscal bearing dislocation after an Oxford MUKA treated with a simple open reduction technique. CLINICAL DISCUSSION Simple open reduction surgery without change of the bearing and the use of knee brace for 6 months was effective in preventing re-dislocation. CONCLUSION Mobile bearing dislocation is one of the most common complications in mobile-bearing MUKA. Besides the prevention of technical errors, usage of UKA with a frequency of 10-15 per year is recommended to increase the surgeon's learning curve.
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Affiliation(s)
- Ludwig Andre Pontoh
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Faculty of Medicine Universitas Indonesia, Jl. RS Fatmawati no. 4, Jakarta Selatan, 12430, Indonesia.
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jl. Diponegoro no. 71, Jakarta Pusat, 10430, Indonesia.
| | - Franky Hartono
- Orthopaedic Center Pantai Indah Kapuk Hospital, Jl. Pantai Indah Utara 3, Jakarta Utara, 14460, Jakarta, Indonesia.
| | - Sholahuddin Rhatomy
- Orthopaedic Department, Soeradji Tirtonegoro Hospital, Klaten, Faculty of Medicine, Public Health of Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Jessica Fiolin
- Jakarta Knee, Shoulder and Orthopaedic Sport Clinic, Pondok Indah Hospital, Jl. Metro Duta Kav UE, Jakarta, 12310, Indonesia.
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Sumarwoto T, Suroto H, Mahyudin F, Utomo DN, Hadinoto SA, Abdulhamid M, Utomo P, Romaniyanto R, Prijosedjati RA, Rhatomy S. Brachial Plexus Injury: Recent Diagnosis and Management. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Brachial plexus injury is known to be one of the most serious upper limb injuries, causes paralysis of the upper limbs and changes in activity of daily living, with the consequence disruption of activity of daily living, socio-economic problems, depression, and hopelessness. Management must be done properly. The evaluation and examination consist of detailed anamnesis on chronological events, complete physical examination, imaging studies, and electrophysiology study. Management can be done nonsurgically and surgically. Knowledge of the history of injury, timing of surgery, priority in restoring function, and managing patient expectations are important concepts in treating patient with brachial plexus injury. Timing is a very important thing. The results of these interventions vary depending on several parameters. Recognizing the basic principles of managing brachial plexus injuries is indispensable for all clinicians who treat these injuries.
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Rhatomy S, Silalahi K, Putra A, Kresonni N. Characteristics of Patellofemoral Measurement in Indonesian Population Using Magnetic Resonance Imaging. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The patellofemoral join is a unique complex joint formed by articulation of the patella and the femoral trochlea. Normal measures for patellofemoral parameters have been published.
AIM: This study aimed to describe the characteristics of patellofemoral measurements in Indonesian population using magnetic resonance imaging (MRI).
METHODS: This descriptive total sampling study was conducted from May 2019 to August 2020. The parameters of the measurements in this study include Insall-Salvati ratio, Caton-Deschamps index, trochlear angle, lateral trochlear inclination, TT (tibia tubercle) – TG (trochlear groove) distance, and trochlear depth. The mean results of the measurements were compared with the normal value measurements that are internationally used.
RESULTS: A total of 100 normal knees MRI scan from patients consisting of 54 (54%) males and 46 (46%) females, with an average age of 35.09 ± 12.77 (19–60) years old. The average body mass index (BMI) was 28.07 ± 3.0 (22–34). Based on ethnicity, subjects were mostly Javanese (66%), Sundanese (12%), Madura (4%), Minangkabau (7%), and the others (11%). The mean of Insall-Salvati ratio was 1.09 ± 0.17 (0.49–1.60). The mean of Caton-Deschamps index was 0.97 ± 0.16 (0.62–1.64). The mean of trochlear angle was 138.97° ± 119.7 (122°–160°). The mean of lateral trochlear inclination was 20.37° ± 4.56 (11.0°–30.6°). The mean of TT-TG distance was 13.76 ± 5.86 (4.9–41), and the mean of trochlear depth was 5.18 ± 1.87 (1.05–8.6). Those values were within normal range of international values. There were no significant differences between comparison of males and females.
CONCLUSION: The means of Insall-Salvati ratio, Caton-Deschamps index, trochlear angle, lateral trochlear inclination, and TT-TG trochlear depth of the Indonesian people were within the international normal range, and higher than other countries’ published measurements.
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Rhatomy S, Rasyid FA. Extension Contracture Post Total Knee Replacement: A Case Report. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stiffness is a common problem after knee arthroplasty and need for further procedure. Patients who experience this problem usually have poor outcome. Flexion contracture is the most reported case in most case reports; however, we reported a rare case of patient with extension contracture after total knee arthroplasty (TKA).
CASE REPORT: A 62-year-old woman was presented with a 3-month history of right TKA. After 3 month she came to the hospital and complained that she could not flex the knee. Nevertheless, she could still walk. On the right knee, there was quadriceps hypotrophy. There was no active and passive range of motion (ROM), because it was fixed at 0°. We performed medial parapatellar approach for knee arthrotomy and we added lateral parapatellar arthrotomy to release the contracture. The fibrotic tissues were removed. The flexion and extension of the knee were evaluated and we managed to get 0–130° of flexion-extension ROM. In the ward, the patient was treated using continuous passive motion (CPM) for 1 week and the CPM was maintained within the range of 0–130°. Six months after surgery, the patient could walk normal with ROM range between 0 and 100°.
CONCLUSION: Stiff knee is a common problem after TKA. Close observation and proper rehabilitation can prevent stiff knee. Close manipulation, manipulation under anesthesia, arthroscopy debridement, and open contracture release are the option of this problem.
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Shofwan S, Liem L, Janitra G, Basuki N, Rhatomy S. Discitis Following Radiofrequency Nucleoplasty: A Case Report. Anesth Pain Med 2020; 10:e110322. [PMID: 34150577 PMCID: PMC8207849 DOI: 10.5812/aapm.110322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Radiofrequency nucleoplasty is a minimally invasive procedure to treat chronic low back pain, especially mild degenerative disc diseases. Discitis after radiofrequency nucleoplasty is a rare case. Case Presentation A 62-year-old male patient with a chief complaint of 10 years low back pain, gradually worsening for the last two years, a history of hypertension, chronic kidney disease, and routine dialysis twice a week, referred to the center. He underwent a lumbar medial branch block using radiofrequency and radiofrequency nucleoplasty procedure of lumbar 4-5 (L4-L5). Three weeks after the intervention, he could not move his legs, associated with urinary and fecal incontinence. MRI (magnetic resonance imaging) of the lumbar spine was performed, and the results indicated hyperintensity in L4-L5, suspicious of discitis. Laminectomy at L4 and L5 was performed. Eight months after surgery, the patient could feel and lift legs, and urinary and fecal incontinence was also controlled. Conclusions Early diagnosis of discitis is critical and challenging. Delay in diagnosis may lead to treatment delay and the development of neurological deficits. Comprehensive treatment with bed rest, antimicrobial therapy, and sensible application of timely surgery are essentials to an optimal outcome.
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Affiliation(s)
- Said Shofwan
- Department of Anesthesiology and Intensive Therapy, Sultan Agung Islamic Hospital, Medical Faculty, Sultan Agung Islamic University, Semarang, Central Java, Indonesia
| | - Liong Liem
- Consultant Pain Management Amsterdam UMC, Universitair Medische Centra (VUmc), Amsterdam, Netherlands
| | - Grady Janitra
- Department of Anesthesiology and Intensive Therapy, Sultan Agung Islamic Hospital, Medical Faculty, Sultan Agung Islamic University, Semarang, Central Java, Indonesia
| | - Nur Basuki
- Department of Anesthesiology and Intensive Therapy, Klaten Islamic Hospital, Klaten, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Corresponding Author: Sholahuddin Rhatomy, Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia / Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Rhatomy S, Lisang R, Soekarno NR, Kisworo B. Evaluation of Quadriceps Strength Post-medial Patellofemoral Ligament Reconstruction Using Quadriceps Tendon Autografts. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Medial patellofemoral ligament (MPFL) reconstruction using quadriceps tendon (QT) grafts provides favorable results with minimal complications and can be performed in patients with open epiphyseal plates. Following MPFL reconstruction using QT grafts, the outcomes have been evaluated, but the residual quadriceps strength (QS) has never been evaluated.
AIM: We analyzed the knee’s range of motion (ROM), thigh circumference (TC), and QS at donor leg sites compared with those at contralateral healthy sites after MPFL reconstruction. The hypothesis was that there is no morbidity at donor sites.
MATERIALS AND METHODS: Patients who underwent MPFL reconstruction using QT autografts between January and December 2017 were recruited. The ROM, TC, and QS were measured 6 months postoperatively.
RESULTS: Twenty-one patients (8 men, 14 women; mean age, 28.40 ± 10.78 years [range, 16–45]) were included in the study. The TCs at the donor and contralateral sites (medians: 37 and 37.5 cm, respectively) showed no significant difference (p = 0.64). QS measurements showed means of 182 ± 4.6 N and 190 ± 4.7 N at the donor and contralateral sites, respectively (p = 0.376). There were no ROM deficits.
CONCLUSIONS: The ROM, TC, and QS at donor sites were similar to those at contralateral sites. The QT is a suitable graft for MPFL reconstruction.
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Rhatomy S, Septiawan EM. Locked knee due to fat pad adhesion. Int J Surg Case Rep 2020; 77:264-268. [PMID: 33189008 PMCID: PMC7672247 DOI: 10.1016/j.ijscr.2020.10.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022] Open
Abstract
Locked Knee. Adhesion. Fat Pad Adhesion. Arthroscopic debridement.
Background A "locked" knee is defined as a knee that does not move freely after an injury. Most cases of locked knee are due to intra-articular blockade caused by an unstable meniscal tear, anterior cruciate ligament (ACL) tear, or chondral lesion resulting in a loose limb. In this study, we present a rare case of a locked knee caused by fat pad adhesion Case presentation A 23-year-old male presented with a locked right knee, after sustaining an injury falling one month before. Magnetic Resonance Imaging showed loss of ACL feature, normal posterior cruciate ligament, and meniscal tear of posterior horn. Arthroscopy procedure found fat pad adhesion, immobilizing the knee’s rotation. After removing all of the fat pad adhesion, the patient’s knee could move freely. Conclusion Clinical and radiographic examinations are important for early diagnosis of the cause of locked knee, but arthroscopic examination is the gold standard for diagnosis.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Eko Medio Septiawan
- Department of Orthopedics and Traumatology, Jogja General Hospital, Yogyakarta, Indonesia
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Rhatomy S, Kisworo B, Prihargono B, Rasyid FA, Kressoni N. Peroneus Longus Tendon Regeneration after Anterior Cruciate Ligament Reconstruction with Magnetic Resonance Imaging Evaluation. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Peroneus longus graft can be recommended as a superior graft over hamstring in anterior cruciate ligament (ACL) reconstruction. There are many studies concerning hamstring tendon regeneration, but there are few studies on the regeneration of the peroneus longus tendon after ACL reconstruction.
AIM: This study aimed to investigate whether regeneration of the peroneus longus tendon occurs after ACL reconstruction with magnetic resonance imaging.
METHODS: Twenty-five patients underwent ACL reconstruction with donors from the peroneus longus tendon by the same operator and were followed 12 months later with bilateral crural magnetic resonance imaging (MRI) for comparison of the donor and healthy peroneus longus tendon areas. Regeneration was assessed at 5 cm, 10 cm, and 15 cm from the ankle joint.
RESULTS: The average age 30.4 (18-38) years old. There were 17 right and 8 left knees involved in this study. The interval between surgery and MRI was 1 year. The average regeneration presentation was located in the distal part (5 cm from the ankle joint) 66.78%, medial part (10 cm from the joint) 63.2%, and proximal part (15 cm from the ankle joint) 67.53%. There was no significant difference in the presentation of proximal, medial, and distal areas while there was a significant difference between age and regeneration of the proximal area, p <0.05 (p = 0.047). Tissue regeneration was tendinous and it appeared smaller in the place where the tendons grew.
CONCLUSION: Regeneration of the peroneus longus tendon occurred after ACL reconstruction at a 1-year follow-up according to MRI.
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Rhatomy S, Phatama KY, Rasyid FA, Mustamsir E. Changes in Orthopedic Services in Two Indonesian Tertiary-referral Hospitals during the Coronavirus-19 Pandemic. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Many countries report decreasing on the number of hospital visit even on the emergency cases.
AIM: This study aims to reveal the important data on how big the impact of coronavirus-19 pandemic on orthopedic services in two Government’s tertiary-referral hospitals.
METHODS: This research is a comparison study to measure the trend of orthopedic services, the monthly orthopedic surgical load and outpatient visit were examined during the period of March to May 2020 (the early pandemic period) then compared to the same period in the 2019.
RESULTS: The lowest number of outpatient visits occurred during May 2020 with 715 total number of outpatient visit. The lowest number of orthopedic surgery occurred during May 2020 with 167 total number of orthopedic surgery. Significant decrease of outpatient visits is recorded in 3 months of early pandemic period compared to the same period in 2019 (p < 0.005). Regarding the orthopedic surgical loads, the data show significant decrease in number of orthopedic surgeries in early pandemic period compared to those months in 2019 (p < 0.005). The largest declines were in visits for post-operative control patient (–179), spinal problem (–127,33), and osteoarthritis (–91,33).
CONCLUSION: There was a significant difference in outpatient visit and orthopedic surgery number in the early pandemic period compared to the period before the pandemic occur.
The largest drops in outpatient visit were in visits for post–operative control patient and spinal problem.
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Wibowo HA, Rhatomy S. Cauda equina syndrome after caudal epidural sacral injection in severe lumbar spinal stenosis: Case report. Int J Surg Case Rep 2020; 77:12-14. [PMID: 33137663 PMCID: PMC7610032 DOI: 10.1016/j.ijscr.2020.10.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022] Open
Abstract
Cauda Equina Syndrome. Caudal Epidural Sacral Injection. Severe Lumbal Spinal Stenosis. Complication.
Introduction Caudal epidural sacral injection is one of the most common conservative treatments for chronic low back pain with radiculopathy. Neurological deficit after injection is a rare complication that must be identified and treated properly. Presentation of case We report a case of cauda equina syndrome that persisted until 3 months after injection. A 63-year-old man came to our department with severe lumbar canal stenosis who experienced motor weakness, buttocks numbness and voiding difficulties immediately after injection. His lower extremities improved after 24 h, but his neurogenic bladder problems and perianal numbness still persisted. We collaborated with our interdisciplinary teams to do a rehabilitation program, and the symptoms were alleviated and he fully recovered within three months. Conclusion Patients with severe stenosis can be best described from magnetic resonance imagery scans, and clinicians should be careful about the risks after injection ranging from transient complications to persistent spinal cord injury.
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Affiliation(s)
- Hastomo Agung Wibowo
- Orthopaedic Traumatology Department, Soeradji Tirtonegoro General Hospital, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia
| | - Sholahuddin Rhatomy
- Orthopaedic Traumatology Department, Soeradji Tirtonegoro General Hospital, Indonesia; Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Indonesia.
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Rhatomy S, Utomo DN, Suroto H, Mahyudin F. Posterior cruciate ligament research output in asian countries from 2009 - 2019: A systematic review. Ann Med Surg (Lond) 2020; 59:76-80. [PMID: 32994987 PMCID: PMC7501478 DOI: 10.1016/j.amsu.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose This study aimed to determine the number of posterior cruciate ligament (PCL) publications performed in Asian countries and to identify factors associated with research output in this region. Materials and methods Searches of existing academic journal articles were performed using PubMed, Google Scholar, and the Cochrane Library from January 1, 2009 until December 31, 2019. Results A total of 265 articles were published in the last 10 years in Asian countries, with an increase in publications after 2010 and an average of 26 articles every year. More than half (70%) of the articles were published in journals with an impact factor (IF) ≥1. The majority of the publications were cohort studies (27%), followed by case reports (16%), systematic reviews/meta-analyses (2.6%), laboratory studies (1.8%), and case-control studies (1.5%). South Korea and China had the most PCL publications, and most authors were from South Korea. Conclusion The PCL research output in Asia is low in quantity but high in quality publications, and the majority of publications come from South Korea, China and Japan, with most being cohort studies and case reports.
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Affiliation(s)
| | - Dwikora Novembri Utomo
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Heri Suroto
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Indonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Indonesia
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Rhatomy S, Yudhistira JF, Soekarno NR, Setyawan R. Iatrogenic injury of posterolateral structures during femoral tunneling in anterior cruciate ligament reconstruction: A cadaveric study. Ann Med Surg (Lond) 2020; 59:14-16. [PMID: 32983441 PMCID: PMC7494821 DOI: 10.1016/j.amsu.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Creating Femoral tunnel in Anterior Cruciate Ligament (ACL) reconstruction can be done through some portal. Transportal technique commonly preferred by Orthopedic Surgeon. However, this technique may possess some iatrogenic injury to knee structure especially in the posterolateral during the drilling. This study aim is to describe the most susceptible injured posterolateral structure of the knee during femoral tunneling from trans portal technique Anterior Cruciate Ligament (ACL) reconstruction. Methods Twenty knees from ten cadavers was examined. Anterior Cruciate Ligament (ACL) reconstruction was simulated using the trans portal technique. Femoral drilling was performed with knee in 120 flexion. The cadaver was dissected to identify the injured posterolateral structure during femoral tunneling. The data collected was anatomy structure and the wound size. Results All Twenty knees were included in the study. 90% of injured structure was iliotibial band. The next most common was plantaris (50%) dan gastrocnemius (45%) muscle. The other was biceps femoris muscle (20%). The least common injury was vastus lateralis (5%). No injury was observed in Lateral Collateral Ligament (LCL), popliteus tendon, and peroneal nerve. Conclusion Transportal technique during femoral drilling in Anterior Cruciate Ligament (ACL) reconstruction does do damage to some of the posterolateral structure. The injury was considered minimal and may not result in function deterioration. There is also no risk to common peroneal nerve. Iatrogenic Injury. Posterolateral Structures. Femoral Tunneling. Anterior Cruciate Ligament Reconstruction. Cadaveric Study.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia/ Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jaka Fatria Yudhistira
- Department of Orthopaedics and Traumatology, Radjak Hospital, Salemba, Jakarta, Indonesia
| | | | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia/ Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Rhatomy S, Wahjudi C, Prasetyo TE, Setyawan R, Budhiparama NC. Functional Outcomes and Hop Tests Results in Anterior Cruciate Ligament Reconstruction Patients with Adjustable Loop Fixation: 2-Years Follow-up. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Grafts are ultimately integrated into the bone tunnels by either screws, cross-pins, or cortical suspension devices in anterior cruciate ligament (ACL) reconstruction. Investigation the usage of adjustable loop button is inadequate.
AIM: The aim of this study was to identify knee functional outcome and serial hop test in ACL reconstruction with adjustable loop button in 2-years follow-up.
METHODS: Chronic isolated ACL ruptured patients were reconstructed with adjustable loop button using peroneus longus autograft. We recorded knee functional outcome score using Tegner-Lysholm score, Modified Cincinnati score, and International Knee Documentation Committee (IKDC) at pre-operative and 2-years follow-up. Serial hop test was assessed at 6 months after surgery.
RESULTS: Forty-seven patients fulfilled inclusion criteria with median age 22.0. Evaluation of functional outcome of Tegner-Lysholm score, Modified Cincinnati score, and IKDC showed significant improvement at 2-years follow-up compared to pre-operative. Serial hop test showed excellent result at 6 months after surgery.
CONCLUSION: The result of knee functional score (Tegner-Lysholm score, Modified Cincinnati score, and IKDC) and serial hop test in ACL reconstruction with adjustable loop using peroneus longus autograft was excellent at 2-years follow-up.
LEVEL OF EVIDENCE: Level 2, Retrospective Cohort Study.
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Rhatomy S, Prasetyo TE, Setyawan R, Soekarno NR, Romaniyanto FNU, Sedjati AP, Sumarwoto T, Utomo DN, Suroto H, Mahyudin F, Prakoeswa CRS. Prospect of stem cells conditioned medium (secretome) in ligament and tendon healing: A systematic review. Stem Cells Transl Med 2020; 9:895-902. [PMID: 32304180 PMCID: PMC7381802 DOI: 10.1002/sctm.19-0388] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/05/2020] [Accepted: 03/22/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tendon or ligament tears can decrease patients' quality of life. Many therapeutic interventions are available to treat such injuries. Mesenchymal stem cells (MSCs) have been shown to be effective in treating tendon or ligament tears; however, the use of stem cell-conditioned medium (CM) requires further investigation. This review focused on the use of stem cell CM as treatment for tendon or ligament tears. METHODS A systematic literature search was performed on PubMed (MEDLINE), OVID, EMBASE, the Cochrane Library, Scopus, Web of Science, and Science Direct with the terms conditioned media or conditioned medium or secretome or microvesicle or extracellular vesicle or exosome, and tendon or ligament as the search keywords. A total of 852 articles were reviewed. Five articles were identified as relevant for this systematic review. RESULTS Meta-analysis could not be performed because of the high heterogeneity of the reviewed studies; however, the results of this study support a positive effect of conditioned media in tendon and ligament treatment. CONCLUSION This review provides evidence of improvement in the tendon and ligament healing process with stem cell CM therapy in preclinical studies.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and TraumatologyDr. Soeradji Tirtonegoro General HospitalKlatenIndonesia
- Faculty of Medicine, Public Health, and NursingUniversitas Gadjah MadaYogyakartaIndonesia
| | - Thomas Edison Prasetyo
- Soeradji Tirtonegoro Sport Center and Research UnitDr. Soeradji Tirtonegoro General HospitalKlatenIndonesia
| | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research UnitDr. Soeradji Tirtonegoro General HospitalKlatenIndonesia
| | | | - FNU Romaniyanto
- Department of Orthopaedics and TraumatologySurakartaIndonesia
- Faculty of MedicineUniversitas Sebelas MaretSurakartaIndonesia
| | - Andi Priyo Sedjati
- Department of Orthopaedics and TraumatologySurakartaIndonesia
- Faculty of MedicineUniversitas Sebelas MaretSurakartaIndonesia
| | - Tito Sumarwoto
- Department of Orthopaedics and TraumatologySurakartaIndonesia
- Faculty of MedicineUniversitas Sebelas MaretSurakartaIndonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedics and TraumatologyDr. Soetomo General HospitalSurabayaIndonesia
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Heri Suroto
- Department of Orthopaedics and TraumatologyDr. Soetomo General HospitalSurabayaIndonesia
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Ferdiansyah Mahyudin
- Department of Orthopaedics and TraumatologyDr. Soetomo General HospitalSurabayaIndonesia
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
| | - Cita Rosita Sigit Prakoeswa
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
- Department of Dermatology and VenereologyDr. Soetomo General HospitalSurabayaIndonesia
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Rhatomy S, Rasyid FA, Phatama KY. The direct anterior approach in total hip arthroplasty: Publication trends of Asian countries on PubMed. Ann Med Surg (Lond) 2020; 55:280-286. [PMID: 32547740 PMCID: PMC7286927 DOI: 10.1016/j.amsu.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background Total hip replacement (THR) is one of the most successful surgical treatment for advanced hip osteoarthritis. Some surgical approaches for THR have been established, one of it is Direct Anterior Approach (DAA), which is a relatively new and less commonly used, especially in Asian countries. This review aims to consolidate information from PubMed on the direct anterior approach (DAA) for total hip replacement (THR) in Asian countries. Purpose To collect and consolidate information from PubMed on the total hip replacement (THR) using the direct anterior approach (DAA) in Asian countries. Methods A search on the PubMed was done for DAA for THR. There were 461 search results about the DAA for THR publications obtained in total, and 51 articles meet the criteria were analyzed for details. The details include top countries publishing the topics, number of publications per year, top 5 journal publishing the DAA for THR topics, top 5 first authors publishing the articles on this topic, and top 5 author on all position published this topic. Results The Journal of Arthroplasty was the leading publisher on this topic, with 10 articles published. Author Yasuhiro Homma, Tomonori Baba, and Kazuhiro Oinuma published the most number with 9 articles as one of the authors. Japan is the leading country for the publication on this topic with 34 published journals in total. Conclusion The number of published articles in Asian country per year is still inconsistent, with one year without any publication on this topic. Searching the data on the DAA for THR in PubMed bestow useful information about good sources of publication on this topic. Direct anterior approach. Total hip arthroplasty. Publication trends. Asian countries.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Faiz Alam Rasyid
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Krisna Yuarno Phatama
- Department of Orthopaedics and Traumatology, Dr Saiful Anwar General Hospital, Malang, Indonesia.,Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Rhatomy S, Hartoko L, Setyawan R, Soekarno NR, Zainal Asikin AI, Pridianto D, Mustamsir E. Single bundle ACL reconstruction with peroneus longus tendon graft: 2-years follow-up. J Clin Orthop Trauma 2020; 11:S332-S336. [PMID: 32523289 PMCID: PMC7275277 DOI: 10.1016/j.jcot.2019.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peroneus longus tendon autograft resembles hamstring tendon's biomechanical strength. Thus, peroneus longus is a potential graft in reconstructive orthopaedic procedures. However, there was few study in evaluation of peroneus longus usage in ACL reconstruction. This study aimed to quantify the clinical outcome and donor site morbidity in ACL reconstruction using peroneus longus tendon autograft. METHODS Patients who suffered isolated ACL injury were enrolled and underwent isolated single bundle ACL reconstruction using peroneus longus autograft. Functional score (IKDC, Modified Cincinnati, and Tegner-Lysholm score) were assessed at pre-operative and 2-years after surgery. Graft diameter was measured intraoperative. Donor site morbidities were assessed with thigh circumference measurement and ankle scoring using AOFAS and FADI. We also measured serial hop test. RESULTS Seventy-five patients fulfilled inclusion criteria. Peroneus longus graft diameter was 8.38 ± 0.68 mm. There was significant difference between pre and 2-years post-operative functional score in IKDC, Modified Cincinnati, and Tegner-Lysholm score. Mean of AOFAS was 98.93 ± 3.10 and FADI was 99.79 ± 0.59 with no significant decrease of thigh circumference, and good serial hop test result. CONCLUSION ACL reconstruction with peroneus longus autograft has excellent functional score in IKDC, Modified Cincinnati, Tegner-Lysholm score at 2-years follow up with the advantages of greater graft diameter, less thigh hypotrophy, good serial hop test result, and excellent ankle function based on AOFAS and FADI score. LEVEL OF EVIDENCE Level 2, Prospective Cohort Study.
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Affiliation(s)
- Sholahuddin Rhatomy
- Sport and Adult Reconstruction Division, Department of Orthopaedics and Traumatology, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia/ Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia,Corresponding author. Sport and Adult Reconstruction Division, Orthopaedics and Traumatology Department, Dr. Soeradji Tirtonegoro General Hospital, Indonesia.
| | - Leonardus Hartoko
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Noha Roshadiansyah Soekarno
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Asa Ibrahim Zainal Asikin
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Dodi Pridianto
- Department of Physical Medicine and Rehabilitation, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Edi Mustamsir
- Department of Orthopaedics and Traumatology, Dr. Syaiful Anwar General Hospital, Malang, Indonesia/Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Rhatomy S, Mahda F, Setyawan R, Prasetyo TE, Budhiparama NC. Iatrogenic Injury to the Posterolateral Knee During Anterior Cruciate Ligament Reconstruction with Anteromedial Portal Technique. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.4216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Femoral tunnel reaming through anteromedial portal, also known as transportal technique, allows for anatomic femoral tunnel placement in restoring anterior cruciate ligament (ACL) kinematics. This procedure may cause iatrogenic injury to the posterolateral structures of the knee.
PURPOSE: This study aims to assess the risk of posterolateral structure injury in ACL reconstruction using transportal technique.
METHODS: ACL reconstruction using transportal technique was performed in 20 patients. Clinical and radiological examination was performed preoperatively and 1 month postoperatively. Clinical examination included any pain or paresthesia on posterolateral area of the knee, varus alignment of the knee, abnormal gait, and specific tests for posterolateral stability. Radiological evaluation was plain radiography and stress radiography for posterolateral stability, and magnetic resonance imaging (MRI) for assessing structural damage.
RESULTS: Post-operative evaluation showed pain in posterolateral area in five patients, numbness on posterolateral knee in one patient, both pain and numbness in two patients and lateral gastrocnemius muscle injury on MRI in six patients. We did not find varus knee alignment and abnormal gait. Specific tests were negative in post-operative evaluation. Post-operative radiographic imaging did not show the sign of lateral widening.
CONCLUSION: Femoral tunnel drilling using transportal technique in ACL reconstruction is safe even it might risk to damage lateral gastrocnemius muscle, according to clinical and MRI findings.
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Rhatomy S, Saspraditya E, Setyawan R. Arthroscopic Standard Anterior and Posteromedial Portal Posterior Cruciate Ligament Reconstruction With Remnant Preservation : 2-Year Follow-up. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Grade 3 posterior cruciate ligament (PCL) injury needs surgical intervention, but there is no consensus on the optimal technique in PCL reconstruction. The old technique always removes the remnant for good visualization of tunnel replacement. Recently, many studies proposed the concept of preservation of PCL remnant with achieve good visualization.
AIM: The aim of the study is to evaluate PCL reconstruction with remnant preservation using the standard anterior and posteromedial portal at 2-year follow-up.
METHODS: We conducted a cohort retrospective study between January 2013 and December 2015. In this study, 25 patients underwent PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation. We used quadrupled hamstring autograft. The patients were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm Knee Score, Modified Cincinnati Score, and knee society score (KSS) at pre-operative and 2-year post-operative. Range of motion (ROM) and complications were evaluated postoperatively.
RESULTS: The mean diameter of the quadruple hamstring graft was 8 mm. Clinical outcomes enhanced significantly (p < 0.05). The average of Lysholm activity scale improved from 65.12 ± 10.48 to 94.96 ± 4.80. The IKDC score improved from 60.50 ± 15.10 to 95.60 ± 3.44. Modified Cincinnati score improved from 62. 28 ± 13.6 to 96.04 ± 1.62. The KSS also improved from 60.12 ± 18.01 to 94.88 ± 6.36. Twenty-two patients had 0–135° full ROM and three patients had 0–110° ROM. Two patients had surgical site infection but recovered with local debridement.
CONCLUSION: PCL reconstruction using the standard anterior and posteromedial portal with remnant preservation at 2-year follow-up resulted in satisfactory clinical and functional outcomes.
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Marliana A, Yudianta S, Subagya DW, Setyopranoto I, Setyaningsih I, Tursina Srie C, Setyawan R, Rhatomy S. The efficacy of pulsed radiofrequency intervention of the lumbar dorsal root ganglion in patients with chronic lumbar radicular pain. Med J Malaysia 2020; 75:124-129. [PMID: 32281592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In recent years, pulsed radiofrequency (PR) has been used as a minimally invasive pain intervention. However, various studies on the efficacy of PR as modalities for the treatment of radicular pain in lumbar disc herniation have had varied results. OBJECTIVE This study aims to determine the efficacy of PR in reducing radicular pain among lumbar disc herniation patients compared with conservative treatment. METHODS This study was conducted using the before-andafter quasi experimental design. There were 50 subjects that fulfilled the inclusion and exclusion criteria and they were divided into an intervention group (n=25) and control group (n=25). The intervention group was given once PR in the dorsal root ganglion. All subjects were assessed for Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) before treatment, at 1- , 2- and 4-week after treatment. RESULTS At1-, 2- and 4-week, the VAS reduction in the intervention group was statistically significant compared to the control group. Four weeks after the intervention, the VAS score decreased in the intervention group (mean VAS -78.5, SD 16.8) more significantly compared to the control group (p<0.001). The ODI score decreased in the intervention group (mean ODI -61.8, SD 20.1) more significantly than in the control group (p<0.001). CONCLUSION Finding showed that at1- , 2- and 4-weekPR was more efficacious in reducing radicular pain among lumbar disc herniation patients compared to the conservative therapy.
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Affiliation(s)
- A Marliana
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Department of Neurology, Klaten, Indonesia
| | - S Yudianta
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Department of Neurology, Klaten, Indonesia
| | - D W Subagya
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Department of Neurology, Klaten, Indonesia
| | - I Setyopranoto
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Department of Neurology, Klaten, Indonesia
| | - I Setyaningsih
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Department of Neurology, Klaten, Indonesia
| | - C Tursina Srie
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Department of Neurology, Klaten, Indonesia
| | - R Setyawan
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
- Dr. Soeradji Tirtonegoro General Hospital, Soeradji Tirtonegoro Sport Center and Research Unit, Klaten, Indonesia
| | - S Rhatomy
- Dr. Soeradji Tirtonegoro General Hospital, Department of Orthopaedics and Traumatology, Klaten, Indonesia.
- Universitas Gadjah Mada, Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
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Rhatomy S, Asikin AIZ, Wardani AE, Rukmoyo T, Lumban-Gaol I, Budhiparama NC. Peroneus longus autograft can be recommended as a superior graft to hamstring tendon in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2019; 27:3552-3559. [PMID: 30877316 DOI: 10.1007/s00167-019-05455-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/28/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE A peroneus longus tendon autograft is used in many orthopaedic procedures and it is biomechanically comparable to a hamstring tendon autograft. Despite its potential, there are few studies that have evaluated the use of the peroneus longus tendon in ACL reconstruction. The aim of this study was to compare the clinical outcome and donor site morbidity of ACL reconstruction with hamstring tendon autografts versus peroneus longus tendon autografts in patients with an isolated ACL injury. METHODS Patients who underwent isolated single-bundle ACL reconstruction were allocated to two groups (hamstring and peroneus longus) and observed prospectively. Graft diameter was measured intraoperatively. Functional scores (IKDC, modified Cincinnati and Lysholm scores) were recorded preoperatively and 1 year after surgery. Donor site morbidities were assessed with thigh circumference measurements and ankle scoring with the AOFAS and FADI. RESULTS Fifty-two patients (hamstring n = 28, peroneus n = 24) met the inclusion criteria. The peroneus longus graft diameter (8.8 ± 0.7 mm) was significantly larger than the hamstring diameter (8.2 ± 0.8 mm) (p = 0.012). There were no significant differences between the pre- and 1-year postoperative score between the hamstring and peroneus longus groups in the IKDC (n.s), modified Cincinnati (n.s), and Lysholm (n.s). The mean for the AOFAS was 97.3 ± 4.2 and for the FADI 98 ± 3.4 in the peroneus longus group, with a significant decrease in thigh circumference in the hamstring group (p = 0.002). CONCLUSION Anterior cruciate ligament reconstruction with peroneus longus autografts produces a functional score (IKDC, modified Cincinnati, Lysholm) comparable to that of hamstring autografts at a 1-year follow-up, with the advantages of larger graft diameter, less thigh hypotrophy and excellent ankle function based on AOFAS and FADI scores. LEVEL OF EVIDENCE Prospective cohort study, Level II.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,RSUP dr. Soeradji Tirtonegoro, Jln. KRT. dr Soeradji Tirtonegoro No. 1, Klaten, Indonesia
| | - Asa Ibrahim Zainal Asikin
- Department of Orthopaedics and Traumatology, Dr Sardjito General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,RSUP dr. Sardjito, Jalan Kesehatan No. 1, Sinduadi, Mlati, Sinduadi, Mlati, Kabupaten Sleman, Daerah Istimewa Yogyakarta, 55281, Indonesia
| | - Anggun E Wardani
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,RSUP dr. Soeradji Tirtonegoro, Jln. KRT. dr Soeradji Tirtonegoro No. 1, Klaten, Indonesia.,Department of Radiology, Dr Soeradji Tirtonegoro General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tedjo Rukmoyo
- Department of Orthopaedics and Traumatology, Dr Sardjito General Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.,RSUP dr. Sardjito, Jalan Kesehatan No. 1, Sinduadi, Mlati, Sinduadi, Mlati, Kabupaten Sleman, Daerah Istimewa Yogyakarta, 55281, Indonesia
| | - Imelda Lumban-Gaol
- Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jl. Jendral Gatot Subroto Kav. 59, 6th floor, Jakarta, 12950, DKI Jakarta, Indonesia
| | - Nicolaas C Budhiparama
- Nicolaas Institute of Constructive Orthopaedics Research and Education Foundation for Arthroplasty and Sports Medicine at Medistra Hospital, Jl. Jendral Gatot Subroto Kav. 59, 6th floor, Jakarta, 12950, DKI Jakarta, Indonesia.
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Rhatomy S, Wicaksono FH, Soekarno NR, Setyawan R, Primasara S, Budhiparama NC. Eversion and First Ray Plantarflexion Muscle Strength in Anterior Cruciate Ligament Reconstruction Using a Peroneus Longus Tendon Graft. Orthop J Sports Med 2019; 7:2325967119872462. [PMID: 31632995 PMCID: PMC6767728 DOI: 10.1177/2325967119872462] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The peroneus longus tendon has been used as a graft in orthopaedic
reconstruction surgery because of its comparable biomechanical strength with
the native anterior cruciate ligament (ACL) and hamstring tendon. However,
one of the considerations in choosing an autograft is donor site
morbidity. Purpose/Hypothesis: This study aimed to compare ankle eversion and first ray plantarflexion
strength between the donor site and its contralateral site after ACL
reconstruction. The study hypothesis was that strength measurements will be
different between the harvest site and contralateral healthy site. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACL reconstruction using a peroneus longus tendon
autograft between March 2017 and December 2018 were included in this study.
Patients followed a rehabilitation protocol from the first day after
surgery. Ankle eversion and first ray plantarflexion strength were measured
using a modified dynamometer 6 months after surgery. Donor site morbidity
was assessed 6 months after surgery using the Foot & Ankle Disability
Index (FADI) and American Orthopaedic Foot & Ankle Society (AOFAS)
scoring system for the ankle and hindfoot. Results: A total of 31 patients (22 male, 9 female; mean age, 27.58 ± 8.69 years
[range, 18.00-45.00 years]) fulfilled the inclusion criteria. There was no
significant difference in ankle eversion strength at the donor site compared
with the contralateral site (P = .55), with means of 65.87
± 7.63 N and 66.96 ± 8.38 N, respectively. Also, there was no significant
difference in ankle first ray plantarflexion strength at the donor site
compared with the contralateral site (P = .68), with means
of 150.64 ± 11.67 N and 152.10 ± 12.16 N, respectively. The mean FADI score
of 99.71 ± 0.57 and mean AOFAS score of 98.71 ± 3.03 at the donor site were
considered excellent results. Conclusion: Ankle eversion and first ray plantarflexion strength at the donor site were
similar to those at the contralateral healthy site, with no donor site
morbidity. This suggests that the peroneus longus tendon is a promising
graft in ACL reconstruction.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Fidelis H Wicaksono
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Noha Roshadiansyah Soekarno
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Shinta Primasara
- Department of Physical Medicine and Rehabilitation, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Nicolaas C Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Jakarta, Indonesia
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Rhatomy S, Horas JA, Asikin AIZ, Setyawan R, Prasetyo TE, Mustamsir E. Clinical Outcome of Arthroscopic Posterior Cruciate Ligament Reconstruction with Adjustable-Loop Femoral Cortical Suspension Devices. Open Access Maced J Med Sci 2019; 7:2791-2795. [PMID: 31844438 PMCID: PMC6901848 DOI: 10.3889/oamjms.2019.644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Incidence of isolated posterior cruciate ligament (PCL) injury is lower than PCL rupture is associated with other knee injuries. Adjustable loop femoral cortical suspension device is commonly used for femoral graft fixation during PCL reconstruction. AIM This study purpose is to describe the functional outcome of PCL reconstruction using an adjustable loop femoral cortical suspension device. METHODS This study used prospective design with consecutive sampling. All patients underwent PCL reconstruction with adjustable loop femoral cortical suspension devices using peroneus longus tendon autograft. Patients were evaluated at 6 months after surgery using posterior drawer test and functional outcome scoring system (Lysholm knee score, Cincinnati Score and International Knee Documentation Committee (IKDC) score). RESULTS 20 patients were enrolled in this study with a mean age of 27.65 ± 9.78. Lysholm knee means the score was improved from 59.80 ± 18.73 pre-operative and 80.55 ± 11.72 post-operative (p < 0.05). Cincinnati mean score was improved from 52.01 ± 20.29 pre-operative to 72.95 ± 15.26 post-operative (p < 0.05). IKDC mean score was improved from 48.36 ± 13.18 at pre-operative to 72.5 ± 13.13 post-operative (p < 0.05). CONCLUSION PCL reconstruction using adjustable loop femoral cortical suspension device using peroneus longus tendon autograft showed good clinical outcome and knee functional outcome (Lysholm, Cincinnati, and IKDC score) at 6 months follow-up.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia.,Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jacky Ardianto Horas
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Asa Ibrahim Zainal Asikin
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Thomas Edison Prasetyo
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Edi Mustamsir
- Department of Orthopaedics and Traumatology, Dr Saiful Anwar General Hospital, Malang, Indonesia.,Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
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Rhatomy S, Purnama H, Singh C, Setyawan R, Utomo DN. Management of valgus knee with irreducible patellar dislocation and MCL rupture: A case series. Int J Surg Case Rep 2019; 60:175-182. [PMID: 31229772 PMCID: PMC6597494 DOI: 10.1016/j.ijscr.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The high rate of recurrence in patellar dislocation treatment, requires a more comprehensive action, this is due to causes not only single but often multifactorial, including problems with static stability, dynamic stability or both. PRESENTATION OF CASE 1st case: A-39-years-old male, complain of irreducible right patella dislocation with valgus knee and already done soft tissue procedure for patella dislocation. Long-leg radiographs of the right leg showed 18° valgus mechanical angle. 2nd case: A-26-years-old obese female, complain of dislocation of left patella and history of surgery for dislocation at 5 years old. Long-leg radiographs of the right leg showed 11° valgus mechanical angle. DISCUSSION After knowing the cause of the patellar dislocation from history taking, physical and supporting examination, we performed lateral open wedge distal femoral osteotomy also MPFL and MCL reconstruction, and tibial tuberosity medialization osteotomy. There is improvement mean score in Tegner Lysholm Knee Scoring system and IKDC Scoring at 6 months after surgery. CONCLUSION Lateral open wedge distal femur osteotomy combine with MPFL and MCL reconstruction and tibial tuberosity medialization realignment procedure can be successfully done for improve irreducible patellar dislocation in valgus knee, from clinical and radiological evaluation have good outcome after surgery.
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Affiliation(s)
- Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia; Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Hendri Purnama
- Fellowship of Hip and Knee, Orthopaedics and Traumatology Department, Dr. Soetomo General Hospital Surabaya, Indonesia
| | - Charanjeet Singh
- Department of Orthopaedics and Traumatology, Gleneagles Hospital Kuala Lumpur, Malaysia
| | - Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Dwikora Novembri Utomo
- Department of Orthopaedics and Traumatology, Dr. Soetomo General Hospital Surabaya, Indonesia
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Setyawan R, Soekarno NR, Asikin AIZ, Rhatomy S. Posterior Cruciate Ligament reconstruction with peroneus longus tendon graft: 2-Years follow-up. Ann Med Surg (Lond) 2019; 43:38-43. [PMID: 31194056 PMCID: PMC6551477 DOI: 10.1016/j.amsu.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 01/11/2023] Open
Abstract
Background Several study that evaluate the usage of peroneus longus tendon (PLT) autograft in Anterior Cruciate Ligament reconstruction shows good result. Regardless the potential, there was no study about the use of PLT autograft in Posterior Cruciate Ligament (PCL) reconstruction. The purpose of this study is to evaluate the functional outcome and donor site morbidity after single bundle PCL reconstruction using PLT autograft. Methods Patient who met inclusion criteria, enrolled to this study and underwent single bundle PCL reconstruction using PL tendon autograft. Clinical outcomes were assessed with International Knee Documentation Committee (IKDC), Modified Cincinnati scoring systems, Lysholm score, and Serial hop test (single hop test and triple hop test) 2-year after surgery. Donor site morbidity was assessed with Foot and Ankle Disability Index (FADI) and American Orthopaedic Foot and Ankle (AOFAS) scoring system. Results Fifteen patients fulfilled the inclusion criteria (11 males and 4 females). PLT graft diameters were 7.5–10 mm (mean: 8.30 ± 0.65 mm). Significant increase of functional score (p < 0.05) were found two years after surgery. Mean score of IKDC was 47.58 ± 11.75 pre-operative; 78.17 ± 4.52 post-operative, Modified Cincinnati was 48.86 ± 12.22 pre-operative; 79.00 ± 4.82 post-operative, Lysholm score was 49.26 ± 11.54 pre-operative; 80.20 ± 5.04 post-operative. FADI and AOFAS at donor site ankle was 93.00 ± 3.04 and 93.26 ± 4.20, respectively. Serial hop test showed good result. Conclusion PCL reconstruction using peroneus longus tendon autograft shows good functional outcome of the knee based on IKDC, Modified Cincinnati, Lysholm score, with preservation of ankle function based on AOFAS and FADI score at 2-years follow-up.
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Affiliation(s)
- Riky Setyawan
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Noha Roshadiansyah Soekarno
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Asa Ibrahim Zainal Asikin
- Soeradji Tirtonegoro Sport Center and Research Unit, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedics and Traumatology, Dr Soeradji Tirtonegoro General Hospital, Klaten, Indonesia
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